Expert report recommends legally regulated heroin sales in BC

published on February 21, 2019

“Heroin Compassion Clubs” could fight fentanyl-related overdoses and disrupt organized crime’s key role in money laundering & housing unaffordability, according to recommendations of the BC Centre on Substance Use

VANCOUVER – COAST SALISH TERRITORY – The BC Centre on Substance Use (BCCSU) is recommending the urgent implementation of a model to reduce overdose deaths while also combating organized crime and the tremendous profitability of the unregulated fentanyl market through the controlled regulation of heroin sales in BC.

In a report released today, the BCCSU proposes establishing heroin compassion clubs for fentanyl-addicted persons to provide access to non-fentanyl-adulterated heroin. Based on the cannabis compassion clubs and medication buyers clubs that emerged during the AIDS crisis to provide access to medical cannabis and antiretroviral medicines, closely regulated heroin compassion clubs could drastically cut fentanyl overdose deaths attributable to organized crime’s grip on the illicit heroin market.

The report, Heroin Compassion Clubs: A Cooperative Model to Reduce Opioid Overdose Deaths & Disrupt Organized Crime’s Role in Fentanyl, Money Laundering & Housing Unaffordability, was written by a group of experts including public health researchers, addiction medicine specialists, and people with lived experience with substance use and recovery. It proposes a cooperative approach through which heroin could be restricted to members and legally obtained from a pharmaceutical manufacturer, while also undertaking scientific evaluation to assess impacts on reducing fentanyl deaths and the undercutting of organized crime.

This model would allow opioid-using members to buy personal amounts of heroin after completing eligibility screening by a health care provider, including an informed consent process aimed at linking users to public health and addiction treatment. The authors argue that restricted legal heroin sales would undercut organized crime and ultimately limit access to youth and other vulnerable populations.

Key benefits of the regulated heroin compassion club model:

Provides a much safer alternative to the fentanyl-adulterated illicit heroin market that is the key driver of opioid deaths by providing a standardized known dosage

Undermines the tremendous profits flowing to organized crime groups that are flooding the local real estate market, contributing to housing unaffordability in the province

Provides facilitated access to public health, free addiction treatment, and referral to recovery services through co-location with the proposed compassion clubs

Allows for revenue generated through a purchasing cooperative model to be redirected in-house to provide access and supports for those without financial means

Prevents opioid addiction by seeking to limit heroin access to individuals using fentanyl

Provides the opioid that most fentanyl-addicted individuals prefer and which most youth and other vulnerable populations view as high risk and relatively unattractive

The proposal comes in response to years of evidence demonstrating that efforts to reduce the flow of both heroin and fentanyl into the province have failed. Violent organized crime groups are presently reaping billions from the illegal fentanyl trade and have interfered in local real estate markets to launder drug profits estimated to be in the billions of dollars annually. Largely as a result of the fentanyl contamination of the heroin market, nearly 1,500 fatal overdoses occurred each year in 2017 and 2018. As a result, for the first time in the province’s history, average life expectancy is dropping.

A range of expert groups including the Health Officer’s Council of British Columbia have long been calling for the controlled regulation of psychoactive substance sales in BC to better protect public health and safety. However, until this time, no strategy to trial and evaluate the approach with a view to maximizing public health and public safety benefits has been articulated. If proven safe and effective, the regulated heroin compassion club model could present a strategy for the regulation of other illegal or unregulated substances where prohibition has failed to reduce supply and contributed to major public health and safety issues.

Dr. Evan Wood; Executive Director, BC Centre on Substance Use:
“The very fabric of BC’s society is fraying due to the combined challenges of organized crime, fentanyl poisonings and money laundering in the province’s housing market and other sectors. As an addiction medicine physician and someone who has spent my career studying solutions to the challenges of addiction, I believe the only path forward for better preventing and treating opioid addiction is to wage economic war on organized crime and to regulate and control the heroin market.”

Erica Thomson; Regional Peer Coordinator, Fraser Health Authority:
“As a person with lived and living experience with recovery and heroin addiction, I know as well as anyone the risks and harms of opioids and what our realities look like in that relationship. The question is how do we also acknowledge and address the intersectional harms of a prohibited and unregulated supply has on the individual and the community while closing the gap between those harms and substance use care and addiction services. You don’t have to be a genius to realize that removing organized crime and the criminalization of people who use drugs from the equation is the answer.”

Dean Wilson; Vancouver Area Network of Drug Users:
“Not a day goes by that I don’t regret starting to use heroin and you won’t find a bigger advocate for youth prevention than me. From personal experience heroin prohibition only serves to make drug available to youth and enrich organized crime – and the fentanyl poisonings we are seeing are really just a natural consequence of prohibition.”

Dr. Keith Ahamad; Medical Director, Regional Addiction Program, Vancouver Coastal Health:
“As an addiction medicine physician working in an emergency department, I see every day the devastating results of fentanyl poisonings. Many of these people need treatment, and we have to do better to ensure they receive it. However, a medicalized approach alone will not solve the diverse problems that prohibition has created. Not everyone who uses opioids lives with addiction, and few people access treatment when their only contact is with a drug dealer, who doesn’t care about their health, safety, and wellbeing. By changing the touch point when purchasing drugs and co-locating with health services, this proposal will improve access to treatment while better restricting access to opioids to vulnerable populations.”

Garth Mullins; BC Association for People on Methadone:
“I’ve been on methadone for 16 years. I’ve had about 50 people I know die from fentanyl overdoses and known lots of people who still use heroin adulterated with fentanyl every day. I don’t want them to die. I want them to have safer access to their opioid of choice – just as I do. And doctors say that substance use disorder – as they call it – is a chronic, relapsing condition. So I could be back there one day myself. Back in the cross hairs. And I want to live.”

Dr. Christy Sutherland; Medical Director, PHS Community Services Society:
“If you look at the situation in the Downtown Eastside, so many of the challenges we face are because of the unregulated drug market. A public health approach where heroin sales are restricted to those using opioids is highly complementary to providing addiction treatment services and will enable us to greatly improve care for all British Columbians.”

External experts have also weighed in on the recommendations

Donald MacPherson; Executive Director, Canadian Drug Policy Coalition:
“There is a desperate need for an urgent and robust public health response to the overdose crisis in BC. The current response has failed to reduce rates of overdose deaths and new approaches must be explored. It’s time for government to join with and support those in the community who are putting forth viable alternatives to the toxic drug supply and the deadly criminally controlled drug market. It’s going to take that kind of partnership and real leadership on the part of policy makers to turn this overdose crisis around.”

Professor Robert Gordon; Professor of Criminology and Associate Dean, Simon Fraser University
“There’s little doubt that the proliferation of fentanyl into the drug supply is a direct result of prohibitionist policies. These policies serve only to line the pockets of organized criminals while endangering our communities through gang violence and a poisoned drug supply. Concentrated efforts must be made to undercut this lucrative drug trade, by bringing this activity into a legal framework, and we should welcome innovative approaches to make this a reality.”

Professor Werner Antweiler; Professor and Chair in International Trade Policy, UBC Sauder School of Business
“We should not look at regulating the heroin market as admitting defeat in the war on drugs; it is about transforming this war. Large numbers of economists and business experts have been speaking out about the harms of prohibition for decades. Indeed, decades of effort have failed to suppress the illegal narcotics trade, which remains hugely profitable. We have the opportunity to take a new approach that wages economic war on organized crime and, I expect, has the potential to better bring addicted people to support services to improve their lives, and ultimately helps to improve the lives of all British Columbians.”

Lisa Lapointe; Chief Coroner, BC Coroners Service:
“British Columbia continues to experience the loss of four people every day to the effects of an unregulated, unmanageable illicit drug market. This strategy, which is designed to immediately and significantly reduce the risk of injury and death, while building community and stability, is an effort worth applauding.”

For more information or to schedule an interview, please contact:
Kevin Hollett, BC Centre on Substance Use
778-918-1537
kevin.hollett@bccsu.ubc.ca